- Children with chronic cough should not undergo treatment for gastroesophageal reflux disease (GERD) in the absence of clinical features.
- To investigate and treat for GERD, clinicians should refer to pediatric GERD guidelines.
Why this matters
- Chronic cough burdens caregivers and providers and erodes QoL.
- GERD is linked to chronic cough in adults, but whether it or gastroesophageal reflux causes chronic cough in children is unclear.
- CHEST Guideline and Expert Panel Report based on systematic reviews (SRs) and randomized controlled trials (RCTs).
- Few prospective data exist.
- For children aged ≤14 years with cough lasting >4 weeks and no underlying lung disease:
- Without GERD symptoms such as regurgitation or heartburn, GERD treatment should not be offered to children to treat chronic cough (grade 1B, based on 4 SRs).
- Treat those with symptoms consistent with reflux by pediatric GERD guidelines (grade 1B, based on 1 RCT and 1 SR); treat 4-8 weeks, reevaluate (ungraded, consensus-based).
- Children should not receive acid-suppressive medications solely to treat cough (grade 1C).
- Test according to pediatric GERD guidelines (ungraded, consensus-based).
- Endoscopy should generally precede pH monitoring.
- Proton pump inhibitors are associated with serious adverse events, such as lower respiratory tract infection.